title: Adoption of hip resurfacing arthroplasty at hospital for special surgery: a cohort study.
abstract: BACKGROUND
  Hip resurfacing arthroplasty (HRA) is an alternative to traditional total hip replacement (THR) that allows for the preservation of femoral bone. It is a more technically difficult procedure that has led some researchers to report an unsatisfactory learning curve (Berend et al., J Bone Joint Surg Am Suppl 2:89-92, 2011; Mont et al., Clin Orthop Relat Res 465:63-70, 2007).
  
  
  OBJECTIVE
  The purpose of this study was to investigate the adoption of HRA at our institution, examining the clinical results, revision rate, and modes of failure. Additionally, a comparison of three different implant systems was performed.
  
  
  METHODS
  A retrospective review of a consecutive series of HRA performed at our institution between the years 2004 and 2009 was carried out. A total of 820 HRA with a minimum of 2 years of follow-up were included in the study. The majority of included patients were males (70%), with osteoarthritis (92%). The average age was 49.8 years, and the mean BMI was 27.5 kg/m(2).
  
  
  RESULTS
  The average Harris hip score improved from 61 to 96.5 postoperatively. Thirteen revisions (1.6%) were performed for femoral neck fracture, femoral head osteonecrosis, acetabular loosening, metal reactivity/metallosis, and metal allergy. The overall Kaplan-Meier survival curve with revision surgery as an endpoint showed 98.5% survival at 5 years. There were no observable differences in clinical scores or revision rates between the different implant systems.
  
  
  CONCLUSIONS
  HRA can be successfully adopted with a low complication rate, given careful patient selection, specialized surgical training, and use of good implant design.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Clinical Orthopaedic Surgery, Weill Cornell Medical College, New York, NY 10065 USA.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Su
authors.forename: Sherwin L
authors.initials: SL
authors.lastname: Su
keywords: complications; hip resurfacing arthroplasty; learning curve; results